Kevin J Clerkin1, Veli K Topkara1, Ryan T Demmer2, Jose M Dizon1, Melana Yuzefpolskaya1, Justin A Fried1, Xingchen Mai1, Donna M Mancini3, Koji Takeda4, Hiroo Takayama4, Yoshifumi Naka4, Paolo C Colombo1, A Reshad Garan5. 1. Department of Medicine, Division of Cardiology, Columbia University College of Physicians and Surgeons, New York, New York. 2. Department of Epidemiology, Columbia University Mailman School of Public Health, New York, New York. 3. Department of Medicine, Division of Cardiology, Icahn School of Medicine at Mount Sinai, New York, New York. 4. Department of Surgery, Division of Cardiac Surgery, Columbia University College of Physicians and Surgeons, New York, New York. 5. Department of Medicine, Division of Cardiology, Columbia University College of Physicians and Surgeons, New York, New York. Electronic address: arg2024@cumc.columbia.edu.
Abstract
OBJECTIVES: This study sought to determine if the presence of implantable cardioverter-defibrillators (ICD) provided a mortality benefit during continuous-flow left ventricular assist device (LVAD) support. BACKGROUND: An ICD decreases mortality in selected patients with advanced heart failure and have been associated with reduced mortality in patients with pulsatile LVAD. However, it is unclear whether that benefit extends to patients with a contemporary continuous-flow LVAD. METHODS: Propensity score matching was used to generate a cohort of patients with similar baseline characteristics. The primary outcome was freedom from death during LVAD support. Secondary endpoints included freedom from unexpected death, likelihood of transplantation and recovery, and adverse events. RESULTS: Among 16,384 eligible patients in the Interagency Registry for Mechanically Assisted Circulatory Support registry, 2,209 patients with an ICD and 2,209 patients without one had similar propensity scores and were included. The presence of an ICD was associated with an increased mortality risk (hazard ratio: 1.20; 95% confidence interval [CI]: 1.04 to 1.39; p = 0.013) and an increased risk of unexpected death during device support (HR: 1.33; 95% CI: 1.03 to 1.71; p = 0.03). Patients with an ICD were more likely to undergo transplantation (HR: 1.16; 95% CI: 0.99 to 1.35; p = 0.06) and less likely to have LVAD explant for recovery (HR: 0.53, 95% CI: 0.29 to 0.98; p = 0.04). Patients with an ICD had a higher rate of treated ventricular arrhythmias (rate ratio: 1.27; 95% CI: 1.10 to 1.48; p = 0.001) and rehospitalization (rate ratio: 1.08; 95% CI: 1.04 to 1.12; p < 0.0001), but rates of hemorrhagic stroke were similar (rate ratio: 1.01; 95% CI: 0.81 to 1.26; p = 0.98). CONCLUSIONS: Among patients with a continuous flow LVAD, the presence of an ICD was not associated with reduced mortality.
OBJECTIVES: This study sought to determine if the presence of implantable cardioverter-defibrillators (ICD) provided a mortality benefit during continuous-flow left ventricular assist device (LVAD) support. BACKGROUND: An ICD decreases mortality in selected patients with advanced heart failure and have been associated with reduced mortality in patients with pulsatile LVAD. However, it is unclear whether that benefit extends to patients with a contemporary continuous-flow LVAD. METHODS: Propensity score matching was used to generate a cohort of patients with similar baseline characteristics. The primary outcome was freedom from death during LVAD support. Secondary endpoints included freedom from unexpected death, likelihood of transplantation and recovery, and adverse events. RESULTS: Among 16,384 eligible patients in the Interagency Registry for Mechanically Assisted Circulatory Support registry, 2,209 patients with an ICD and 2,209 patients without one had similar propensity scores and were included. The presence of an ICD was associated with an increased mortality risk (hazard ratio: 1.20; 95% confidence interval [CI]: 1.04 to 1.39; p = 0.013) and an increased risk of unexpected death during device support (HR: 1.33; 95% CI: 1.03 to 1.71; p = 0.03). Patients with an ICD were more likely to undergo transplantation (HR: 1.16; 95% CI: 0.99 to 1.35; p = 0.06) and less likely to have LVAD explant for recovery (HR: 0.53, 95% CI: 0.29 to 0.98; p = 0.04). Patients with an ICD had a higher rate of treated ventricular arrhythmias (rate ratio: 1.27; 95% CI: 1.10 to 1.48; p = 0.001) and rehospitalization (rate ratio: 1.08; 95% CI: 1.04 to 1.12; p < 0.0001), but rates of hemorrhagic stroke were similar (rate ratio: 1.01; 95% CI: 0.81 to 1.26; p = 0.98). CONCLUSIONS: Among patients with a continuous flow LVAD, the presence of an ICD was not associated with reduced mortality.
Authors: Marwan M Refaat; Toshikazu Tanaka; Robert L Kormos; Dennis McNamara; Jeffrey Teuteberg; Steve Winowich; Barry London; Marc A Simon Journal: J Card Fail Date: 2011-12-22 Impact factor: 5.712
Authors: Maurizio Gasparini; Alessandro Proclemer; Catherine Klersy; Axel Kloppe; Maurizio Lunati; José Bautista Martìnez Ferrer; Ahmad Hersi; Marcin Gulaj; Maurits C E F Wijfels; Elisabetta Santi; Laura Manotta; Angel Arenal Journal: JAMA Date: 2013-05-08 Impact factor: 56.272
Authors: Gust H Bardy; Kerry L Lee; Daniel B Mark; Jeanne E Poole; Douglas L Packer; Robin Boineau; Michael Domanski; Charles Troutman; Jill Anderson; George Johnson; Steven E McNulty; Nancy Clapp-Channing; Linda D Davidson-Ray; Elizabeth S Fraulo; Daniel P Fishbein; Richard M Luceri; John H Ip Journal: N Engl J Med Date: 2005-01-20 Impact factor: 91.245
Authors: A J Moss; W J Hall; D S Cannom; J P Daubert; S L Higgins; H Klein; J H Levine; S Saksena; A L Waldo; D Wilber; M W Brown; M Heo Journal: N Engl J Med Date: 1996-12-26 Impact factor: 91.245
Authors: Silvia G Priori; Carina Blomström-Lundqvist; Andrea Mazzanti; Nico Blom; Martin Borggrefe; John Camm; Perry Mark Elliott; Donna Fitzsimons; Robert Hatala; Gerhard Hindricks; Paulus Kirchhof; Keld Kjeldsen; Karl-Heinz Kuck; Antonio Hernandez-Madrid; Nikolaos Nikolaou; Tone M Norekvål; Christian Spaulding; Dirk J Van Veldhuisen Journal: Eur Heart J Date: 2015-08-29 Impact factor: 29.983
Authors: Markus C Elze; John Gregson; Usman Baber; Elizabeth Williamson; Samantha Sartori; Roxana Mehran; Melissa Nichols; Gregg W Stone; Stuart J Pocock Journal: J Am Coll Cardiol Date: 2017-01-24 Impact factor: 24.094
Authors: Nisha Bansal; Adam Szpiro; Kristi Reynolds; David H Smith; David J Magid; Jerry H Gurwitz; Frederick Masoudi; Robert T Greenlee; Grace H Tabada; Sue Hee Sung; Ashveena Dighe; Alan S Go Journal: JAMA Intern Med Date: 2018-03-01 Impact factor: 21.873
Authors: Evgenij V Potapov; Christiaan Antonides; Maria G Crespo-Leiro; Alain Combes; Gloria Färber; Margaret M Hannan; Marian Kukucka; Nicolaas de Jonge; Antonio Loforte; Lars H Lund; Paul Mohacsi; Michiel Morshuis; Ivan Netuka; Mustafa Özbaran; Federico Pappalardo; Anna Mara Scandroglio; Martin Schweiger; Steven Tsui; Daniel Zimpfer; Finn Gustafsson Journal: Eur J Cardiothorac Surg Date: 2019-08-01 Impact factor: 4.191
Authors: Ashwin Ravichandran; Naga Venkata K Pothineni; Jaimin R Trivedi; Henri Roukoz; Mustafa M Ahmed; Adarsh Bhan; Geetha Bhat; Jennifer Cowger; Amin Al Ahmad; Andrea Natale; Luigi Di Biase; Mark S Slaughter; Dhanunjaya Lakkireddy; Rakesh Gopinathannair Journal: Heart Rhythm O2 Date: 2021-12-17